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  • Chest Physical Therapy

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    Julia Salvio
    271 views28 pages
    This document provides an overview of various breathing exercises and techniques used in chest physical therapy, including diaphragmatic breathing, segmental breathing, pursed-lip breathing, glossopharyngeal breathing, chest mobilization exercises, coughing techniques, and postural drainage positions. The goals are to improve ventilation, mobilize secretions, and prevent/relieve dyspnea. Key techniques involve diaphragmatic breathing in various positions, applying resistance during inhalation to expand specific rib areas, and pursed-lip exhalation during dyspnea. Postural drainage involves positioning the patient in various positions to drain secretions from lung segments.

    Original Description:

    CHES PT

    Original Title

    Chest-PT

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    This document provides an overview of various breathing exercises and techniques used in chest physical therapy, including diaphragmatic breathing, segmental breathing, pursed-lip breathing, glossopharyngeal breathing, chest mobilization exercises, coughing techniques, and postural drainage positions. The goals are to improve ventilation, mobilize secretions, and prevent/relieve dyspnea. Key techniques involve diaphragmatic breathing in various positions, applying resistance during inhalation to expand specific rib areas, and pursed-lip exhalation during dyspnea. Postural drainage involves positioning the patient in various positions to drain secretions from lung segments.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Download as pptx, pdf, or txt
    271 views28 pages

    Chest Physical Therapy

    Uploaded by

    Julia Salvio
    This document provides an overview of various breathing exercises and techniques used in chest physical therapy, including diaphragmatic breathing, segmental breathing, pursed-lip breathing, glossopharyngeal breathing, chest mobilization exercises, coughing techniques, and postural drainage positions. The goals are to improve ventilation, mobilize secretions, and prevent/relieve dyspnea. Key techniques involve diaphragmatic breathing in various positions, applying resistance during inhalation to expand specific rib areas, and pursed-lip exhalation during dyspnea. Postural drainage involves positioning the patient in various positions to drain secretions from lung segments.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 28

    Chest

    Physical Therapy
    Breathing Exercises and Ventilatory
    Training
    Diaphragmatic Breathing
    Segmental Breathing
    Pursed-Lip Breathing
    Preventing and Relieving Episodes of
    Dyspnea
    Glossopharyngeal Breathing
    Exercises to Mobilize the Chest
    Coughing
    Postural Drainage
    Diaphragmatic Breathing
     Rationale: Improve efficiency of ventilation, decrease
    work of breathing, mobilize lung secretions

     Pt position: Gravity-assisted position for diaphragm,


    e.g. semi-reclined or semi-Fowler’s position

     Stabilization/manual contact: On rectus abdominis


    just below anterior costal margin
    Diaphragmatic Breathing
     Inhale through nose, shoulders relaxed and
    upper chest quiet
     Relax and exhale through mouth
     If having
    difficulty using
    diaphragm, have
    pt inhale
    successively
    through sniffing
    Segmental Breathing
    ateral Costal Expansion
     Indication: For pt with stiff lower rib cage (chronic
    bronchitis, emphysema, asthma)

     Pt Position: Begin in a hook-lying position,


    progress to sitting

     Stabilization/manual contact: Lateral aspect of the


    lower ribs
    Segmental Breathing
    ateral Costal Expansion
     Instructions: As pt breathes out, place pressure on
    ribs with palms of your hands
     Apply light manual
    resistance to lower ribs as pt
    breathes in deeply
    Segmental Breathing
    ateral Costal Expansion
     Home Instruction: Teach pt to perform maneuver
    independently using hands or with a towel or belt
    Segmental Breathing
    osterior Basal Expansion
     Indication: For pt in a semi-reclined position for an
    extended period (accumulation of secretions in
    posterior segments of lower lobe)

     Pt Position: Pt sitting and leaning forward on pillow,


    slightly bending hips

     Stabilization/manual contact: Posterior aspect of the


    lower ribs
    Segmental Breathing
    osterior Basal Expansion
     Instructions: As pt breathes out, place pressure
    on ribs with palms of your hands

     Apply light manual resistance to


    lower ribs as pt breathes in deeply
    Pursed-Lip Breathing
     Indication: During episodes of dyspnea

     Pt Position: Comfortable, relaxed position

    Stabilization/manual contact: Abdominals

     Instructions: Inhale through the nose then exhale through


    lightly pursed lips as if “bending the flame of a candle but
    not blowing it out”
    Preventing and Relieving Episodes
    of Dyspnea
    Indication: During episodes of dyspnea

    Pt Position: Relaxed, forward-head


    posture

    Instructions: Ask pt to perform


    diaphragmatic breathing with pursed-lip
    exhalation
    Glossopharyngeal Breathing
     Indications: ↓ ventilator dependence, emergency
    procedure during ventilator malfunction, improve force
    of cough, increase volume of voice

     Pt Position: Relaxed position

    Instructions: “Gup” 6-10x in series


    Exercises to Mobilize the Chest
    o Mobilize One Side of Chest
     Rationale: Maintain/improve mobility of chest wall, trunk, and
    shoulder girdles when it affects ventilation/postural alignment
     Pt Position: Sitting
     Instructions:
    Push fisted hand
    into lateral chest
    and bend towards
    Bend away from tight side during
    tight side during expiration
    inspiration
    Exercises to Mobilize the Chest
    Mobilize the Upper Chest and Stretch the Pectoralis Muscles
     Pt Position: Sitting, hands clasped behind head
    Instructions:
    Horizontally abduct arms
    (move elbows backward)
    during inspiration

    Bring elbows together


    and bend forward
    during expiration
    Exercises to Mobilize the Chest
    Mobilize the Upper Chest and Shoulders
     Pt Position: Sitting
     Instructions:

    Reach with (B) arms


    overhead during
    inspiration

    Bend forward at the


    hips and reach for the
    floor during expiration
    Teaching an Effective Cough
     Rationale: Integral component of airway clearance

     Pt Position: Sitting/leaning forward, neck slightly


    flexed

     Instructions:
    • Teach pt controlled diaphragmatic breathing
    • Demonstrate double cough
    • Demonstrate proper muscle action of coughing
    (abdominals contraction). Practice making “K”
    sound.
    Additional Techniques to Facilitate a Cough
    and Improve Airway Clearance
    anual-Assisted Cough (Therapist-Assisted)
     Pt Position: Supine/semi-reclining position

     Stabilization/manual contact: Place heel of one hand


    over epigastric area distal to xiphoid process, other
    hand on top of the first

     Instructions: Ask pt to cough, assist by compressing


    with inward and upward force
    Additional Techniques to Facilitate a Cough
    and Improve Airway Clearance
    nual-Assisted Cough (Therapist-Assisted/Self-Assisted)
    Manual Techniques Used with
    Postural Drainage Therapy
    ercussion, Vibration, Shaking
     Contraindications:
    Over fractures, spinal fusion, osteoporotic bone
    Over tumor area
    Pulmonary embolus
    Hemorrhage could easily occur
    Unstable angina
    Chest wall pain
    Manual Techniques Used with
    Postural Drainage Therapy
    Percussion Vibration Shaking
     PT’s cupped  Applied only  More vigorous
    hands strike pt’s during expiratory form of vibration,
    chest wall in phase of deep applied during
    alternating, breathing exhalation
    rhythmic manner  PT places (B)  Thumbs locked
    hands directly on together, open
    skin, gently hands over pt’s skin,
    compressing and fingers around chest
    wall
    rapidly vibrating as
    pt breathes out Compress and
    shake pt’s chest wall
    Postural Drainage
     Considerations:
     Never administer after a meal
     Coordinate with aerosol therapy
     Choose time/s of day likely to be most beneficial to
    pt
     Preparations:
     Loosen tight/bulky clothing
     Have sputum cup and tissues available
     Have sufficient pillows
     Teach pt deep breathing and effective cough
     Adjust tubes and wires
    Postural Drainage
     Sequence:
    1. Determine which segments should be drained.
    2. Check vital signs and breath sounds.
    3. Position in the correct position for drainage.
    4. Stand in front on pt to observe color.
    5. Maintain position for 5-10 minutes/as long as position is
    productive.
    6. Have pt breathe deeply during drainage without
    hyperventilating.
    7. Apply percussion over segment being drained.
    8. Encourage pt to take a deep, sharp, double cough when
    necessary.
    9. Duration should not exceed 45-60 minutes.
    Postural Drainage
     Sequence:
    1. Determine which segments should be drained.
    2. Check vital signs and breath sounds.
    3. Position in the correct position for drainage.
    4. Stand in front on pt to observe color.
    5. Maintain position for 5-10 minutes/as long as position is
    productive.
    6. Have pt breathe deeply during drainage without
    hyperventilating.
    7. Apply percussion over segment being drained.
    8. Encourage pt to take a deep, sharp, double cough when
    necessary.
    9. Duration should not exceed 45-60 minutes.
    Postural Drainage Positions – Upper Lobes

    Under the clavicle

    Above scapulae

    Directly over nipple/ above breast


    Postural Drainage Positions – Upper Lobes

    Directly over (L) scapula

    Directly over (R) scapula

    ~18 in
    Postural Drainage Positions
    Just
    und
    er (
    L) c
    h es
    t

    Under (R
    ) chest
    Postural Drainage Positions – Lower Lobes

    Bilaterally over lower potion of ribs


    Postural Drainage Positions – Lower Lobes

    Low
    Low er l
    ate
    er l ra l (R
    ate ) rib
    ra l (L
    ) rib cag
    e
    cag
    e

    Bilaterally, directly below scapulae

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